In this article, we draw on five case studies in health care organizations
to develop a process theory of strategic change in pluralistic settings cha
racterized by diffuse power and divergent objectives. The creation of a col
lective leadership group in which members play complementary roles appears
critical in achieving change. However, collective leadership is fragile. We
identify three levels of "coupling" between leaders, organization, and env
ironment that need to be mobilized to permit change. Since it is difficult
to maintain coupling at all levels simultaneously, change tends to proceed
sporadically, driven by the effects of leaders' actions on their political
positions.